Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 151: Open neural tube defects are best detected by an increase in which of the following enzymes?

A. Acetylcholinesterase (Correct Answer)
B. Pseudocholinesterase
C. AFP
D. hCG

Explanation: **Explanation:** The detection of open neural tube defects (ONTDs) relies on the leakage of fetal substances into the amniotic fluid through the exposed neural tissue. **Why Acetylcholinesterase (AChE) is the correct answer:** Acetylcholinesterase is an enzyme found specifically in high concentrations within the fetal central nervous system (synapses). In cases of **open** neural tube defects (like anencephaly or open spina bifida), this enzyme leaks directly into the amniotic fluid. While Alpha-fetoprotein (AFP) is used as a screening tool, **AChE is the most specific confirmatory biochemical marker** for ONTDs. Its presence in amniotic fluid (detected via electrophoresis) helps differentiate a true neural tube defect from other causes of elevated AFP. **Analysis of Incorrect Options:** * **B. Pseudocholinesterase:** This is a non-specific cholinesterase found in the liver and plasma. It is not a specific marker for fetal neural tissue. * **C. AFP (Alpha-fetoprotein):** While AFP levels *do* increase in ONTDs, the question asks for an **enzyme**. AFP is a glycoprotein, not an enzyme. Furthermore, AFP can be elevated in other conditions (omphalocele, gastroschisis, multiple gestations), making it less specific than AChE. * **D. hCG:** Human Chorionic Gonadotropin is a marker for pregnancy, gestational trophoblastic disease, and certain chromosomal trisomies (like Down syndrome), but it has no diagnostic value for neural tube defects. **High-Yield Clinical Pearls for NEET-PG:** * **Screening vs. Diagnosis:** Maternal Serum AFP (MSAFP) is the screening test (done at 15–20 weeks); Amniotic fluid AChE is the confirmatory biochemical test. * **Closed NTDs:** AChE and AFP levels remain **normal** in skin-covered (closed) defects like spina bifida occulta. * **Prevention:** Periconceptional Folic acid (400 mcg/day for low risk; 4 mg/day for high risk) reduces the incidence of NTDs.

Question 152: Which of the following is NOT an acceptable contraceptive method for a lactating mother?

A. Barrier method
B. Combined oral contraceptive pill (Correct Answer)
C. Lactational amenorrhoea method
D. Progesterone-only pill

Explanation: **Explanation:** The correct answer is **Combined Oral Contraceptive Pill (COCP)**. The primary reason COCPs are contraindicated in lactating mothers, particularly in the early postpartum period (first 6 months), is that the **estrogen** component suppresses prolactin activity. This leads to a significant reduction in both the **quantity and quality (protein content) of breast milk**, potentially compromising the infant's nutrition. Furthermore, there is an increased risk of venous thromboembolism (VTE) in the early postpartum weeks, which is exacerbated by estrogen. **Analysis of other options:** * **Barrier Methods (Condoms/Diaphragms):** These are non-hormonal and have no effect on milk production or infant safety, making them safe at any time postpartum. * **Lactational Amenorrhoea Method (LAM):** This is a physiological contraceptive method. It is effective for up to 6 months if the mother is exclusively breastfeeding, remains amenorrheic, and feeds the baby at regular intervals (including night feeds). * **Progesterone-only Pill (POP):** Also known as the "Minipill," POPs do not contain estrogen and therefore do not interfere with lactation. They are the hormonal pill of choice for breastfeeding mothers. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Medical Eligibility Criteria (MEC):** COCPs are **MEC Category 4** (absolute contraindication) if <3 weeks postpartum and **MEC Category 3** if between 3 weeks to 6 months postpartum in breastfeeding women. * **Ideal Time for IUCD:** Can be inserted within 48 hours (Postpartum IUCD) or after 6 weeks (Interval IUCD). * **DMPA (Injectable):** Can be safely started 6 weeks postpartum in lactating mothers. * **Centchroman (Saheli):** This non-steroidal SERM is safe during lactation as it does not affect milk secretion.

Question 153: Which of the following is NOT true about spermicidal agents?

A. Contain non-ionic surfactants causing osmotic changes resulting in the killing of sperms.
B. They act as a physical barrier to sperm transport.
C. 'Immediate douching' is a must after intercourse to avoid irritant action. (Correct Answer)
D. Do not have STD/HIV protection action.

Explanation: **Explanation:** Spermicides are chemical contraceptives that work primarily by destroying the sperm cell membrane. **Why Option C is the Correct Answer (The False Statement):** Immediate douching after intercourse is **contraindicated** when using spermicides. For maximum efficacy, the spermicide must remain in contact with the cervix and vagina for at least **6 hours** after coitus. Douching immediately would wash away the active agent before it has completely neutralized all sperm, significantly increasing the risk of pregnancy. While spermicides can occasionally cause local irritation or vaginal candidiasis, douching is not the recommended management for this. **Analysis of Other Options:** * **Option A:** Most spermicides (like **Nonoxynol-9**) are non-ionic surfactants. They reduce the surface tension of the sperm membrane, causing osmotic imbalance, leakage of cell contents, and death of the sperm. * **Option B:** Many spermicidal formulations (foams, jellies, and suppositories) provide a secondary **mechanical/physical barrier** by covering the external os, preventing sperm from entering the cervical canal. * **Option C:** Contrary to earlier beliefs, spermicides **do not protect against STDs or HIV**. In fact, frequent use of Nonoxynol-9 can cause vaginal/cervical micro-abrasions, which may actually **increase** the risk of HIV transmission. **High-Yield Clinical Pearls for NEET-PG:** * **Active Ingredient:** Nonoxynol-9 is the most commonly used agent in India (e.g., Today tablet). * **Failure Rate:** High typical-use failure rate (~18-28%). * **Application:** Must be inserted high into the vagina near the cervix about 10–15 minutes before intercourse. * **Vaginal pH:** Spermicides work best in an acidic environment; semen (alkaline) can sometimes reduce their efficacy.

Question 154: The first dose of oral contraceptive pills for emergency contraception should be taken within how many hours?

A. 24 hours
B. 48 hours
C. 72 hours (Correct Answer)
D. 96 hours

Explanation: **Explanation:** The primary mechanism of hormonal emergency contraception (EC) is to delay or inhibit ovulation. For maximum efficacy, the first dose must be administered as soon as possible after unprotected intercourse, ideally within **72 hours (3 days)**. This timeframe corresponds to the window before the LH surge triggers ovulation and before fertilization/implantation can occur. **Analysis of Options:** * **72 hours (Correct):** Standard guidelines (WHO and MoHFW) recommend the use of Levonorgestrel (LNG) 1.5 mg or the Yuzpe regimen within 72 hours. While some efficacy remains up to 120 hours, the failure rate increases significantly after the 72-hour mark. * **24 & 48 hours (Incorrect):** While taking the pill within these windows is highly effective (the sooner, the better), they do not represent the maximum clinical "cutoff" window typically tested in exams. * **96 hours (Incorrect):** This exceeds the standard recommended window for traditional LNG-based emergency pills. **High-Yield Clinical Pearls for NEET-PG:** 1. **Drug of Choice:** Levonorgestrel (1.5 mg single dose) is the preferred hormonal EC due to better tolerability and higher efficacy than the Yuzpe regimen (Ethinylestradiol + Levonorgestrel). 2. **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM) that is effective up to **120 hours (5 days)** and is more effective than LNG in obese women. 3. **Most Effective EC:** The **Copper-T (Cu-T 380A)** IUD is the most effective emergency contraceptive and can be inserted up to **5 days** after unprotected intercourse. 4. **Centchroman (Chhaya):** A non-steroidal SERM used for routine contraception (twice weekly for 3 months, then weekly), but **not** used for emergency contraception.

Question 155: Which of the following is NOT a method of permanent sterilization?

A. Electrocoagulation
B. Vasectomy
C. Clipping
D. Medroxyprogesterone (Correct Answer)

Explanation: **Explanation:** The question asks to identify the method that is **NOT** a permanent form of sterilization. **Correct Option: D. Medroxyprogesterone** Medroxyprogesterone acetate (DMPA), commonly known as **Antara** in the government program, is a **reversible, long-acting injectable contraceptive (LAIC)**. It is administered intramuscularly every 3 months (150 mg). It works primarily by inhibiting ovulation through the suppression of FSH and LH. Since its effects wear off after discontinuation, it is classified as a temporary hormonal method, not permanent sterilization. **Analysis of Incorrect Options:** * **A. Electrocoagulation:** This is a surgical method of female sterilization (tubal ligation) where an electric current is used to cauterize and destroy a segment of the fallopian tubes, creating a permanent blockage. * **B. Vasectomy:** This is the permanent sterilization procedure for males. It involves the surgical ligation or occlusion of the **vas deferens** to prevent sperm from entering the ejaculate. * **C. Clipping:** This refers to the application of mechanical devices (like the **Hulka-Clemens clip** or Filshie clip) to the fallopian tubes. It is a recognized method of permanent tubal occlusion. **High-Yield Clinical Pearls for NEET-PG:** * **Failure Rates (Pearl Index):** Vasectomy (0.1%) is generally more effective and has fewer complications than tubal ligation (0.5%). * **Post-Vasectomy Advice:** Sterility is not immediate. A man is considered sterile only after **two consecutive negative semen analyses** or after **3 months (or 20 ejaculations)**. * **DMPA Side Effect:** The most common side effect of Medroxyprogesterone is **irregular menstrual bleeding** or amenorrhea, and a potential delay in the return of fertility (up to 7–10 months).

Question 156: Which of the following is NOT a mechanism by which an Intrauterine Contraceptive Device (IUCD) acts?

A. Chronic endometrial inflammation
B. Increased motility of the fallopian tubes
C. Inducing endometrial atrophy
D. Inhibition of ovulation (Correct Answer)

Explanation: **Explanation:** The primary mechanism of action for Intrauterine Contraceptive Devices (IUCDs) is to create a local environment that is hostile to sperm and prevents fertilization. **Why "Inhibition of Ovulation" is the correct answer:** IUCDs (both Copper and Hormonal) are **non-anovulatory** methods of contraception. They act locally within the uterus and do not suppress the Hypothalamic-Pituitary-Ovarian (HPO) axis. Therefore, patients using an IUCD continue to have regular ovulatory cycles. **Analysis of incorrect options:** * **Chronic endometrial inflammation:** Copper IUCDs (e.g., Cu-T 380A) act as a foreign body, inducing a sterile inflammatory response in the endometrium. This leads to the release of cytokines and macrophages which are spermicidal and prevent implantation. * **Increased motility of the fallopian tubes:** IUCDs alter the tubal and uterine motility, which interferes with the transport of the gametes (sperm and ovum), ensuring they do not meet at the right time for fertilization. * **Inducing endometrial atrophy:** This is the hallmark of **Hormonal IUCDs (LNG-IUD/Mirena)**. The continuous release of levonorgestrel leads to profound endometrial atrophy and thickening of cervical mucus, preventing sperm penetration. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect of Cu-T:** Menorrhagia (Bleeding). * **Most common reason for removal of Cu-T:** Pain followed by bleeding. * **Ideal time for insertion:** Within 10 days of the menstrual cycle (to ensure the patient is not pregnant). * **LNG-IUD (Mirena):** Is the **Drug of Choice (DOC)** for Menorrhagia (DUB) and provides protection against Endometrial Hyperplasia. * **Mechanism of Cu-T:** Primarily **spermicidal** (Copper ions inhibit sperm motility and viability).

Question 157: The use of combined oral contraceptive pills is associated with an increased incidence of which of the following conditions?

A. Bacterial vaginosis
B. Chlamydial endocervicitis (Correct Answer)
C. Vaginal warts
D. Genital herpes

Explanation: **Explanation:** The correct answer is **Chlamydial endocervicitis**. **Why it is correct:** Combined Oral Contraceptive Pills (COCPs) contain estrogen, which induces a physiological change in the cervix known as **cervical ectopy (ectropion)**. In this process, the delicate columnar epithelium of the endocervix migrates outward onto the vaginal portion of the cervix (ectocervix). Since *Chlamydia trachomatis* has a specific tropism for columnar epithelial cells, the increased surface area of exposed columnar tissue significantly increases the risk of acquiring chlamydial endocervicitis. Additionally, COCP users may practice less consistent barrier protection (condom use), further increasing the risk of sexually transmitted infections (STIs). **Analysis of Incorrect Options:** * **Bacterial Vaginosis (BV):** COCPs are generally considered **protective** against BV. Estrogen increases glycogen content in vaginal epithelial cells, which is fermented by *Lactobacilli* to produce lactic acid. This maintains a low vaginal pH, inhibiting the overgrowth of anaerobic bacteria associated with BV. * **Vaginal Warts (HPV) & Genital Herpes (HSV):** While COCP users may have higher exposure risks due to behavioral factors (lack of barrier protection), there is no direct physiological mechanism (like ectopy) that specifically increases the incidence of these viral infections compared to Chlamydia. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects of COCPs:** Significantly reduces the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Benign breast disease**. * **Increased Risks:** COCPs are associated with an increased risk of **Cervical cancer** (especially with >5 years of use), **Breast cancer** (slight increase), and **Hepatic adenoma**. * **Cervical Ectopy:** It is a physiological condition in pregnancy and COCP users; it does not require treatment unless symptomatic (e.g., post-coital bleeding).

Question 158: Which of the following is NOT a mechanism of action of oral contraceptive pills (OCPs)?

A. Inhibition of ovulation
B. Induction of an out-of-phase endometrium
C. Alteration of cervical mucus
D. None of the above (Correct Answer)

Explanation: **Explanation:** The correct answer is **D (None of the above)** because all the listed options (A, B, and C) are established mechanisms of action for Combined Oral Contraceptive Pills (COCPs). COCPs prevent pregnancy through a multi-pronged approach: 1. **Inhibition of Ovulation (Primary Mechanism):** The estrogen component (usually Ethinyl Estradiol) suppresses Follicle Stimulating Hormone (FSH), preventing follicular development. The progestogen component suppresses Luteinizing Hormone (LH), preventing the LH surge and subsequent ovulation. 2. **Alteration of Cervical Mucus:** Progestogen makes the cervical mucus thick, viscid, and scanty. This creates a "hostile" environment that acts as a physical barrier to sperm penetration. 3. **Endometrial Changes:** OCPs induce an "out-of-phase" or atrophic endometrium. This makes the uterine lining unreceptive to the implantation of a blastocyst, even if fertilization were to occur. **Why other options are incorrect:** * **Option A, B, and C** are all correct physiological effects of OCPs. Since the question asks for which is *NOT* a mechanism, and all three are valid mechanisms, "None of the above" is the only logical choice. **High-Yield NEET-PG Pearls:** * **Most important mechanism:** Inhibition of ovulation via suppression of the Hypothalamic-Pituitary-Ovarian (HPO) axis. * **Progesterone-only pills (POPs):** Their primary mechanism is the alteration of cervical mucus rather than the consistent inhibition of ovulation. * **Pearl:** OCPs provide significant non-contraceptive benefits, including a reduced risk of **Ovarian and Endometrial cancers** (protective effect lasts for years after discontinuation). * **Contraindication:** OCPs are strictly contraindicated in smokers over 35 years of age due to the high risk of thromboembolism.

Question 159: Which of the following is an adverse effect of combined oral contraceptive pills?

A. Liver disorders (Correct Answer)
B. Pelvic inflammatory disease (PID)
C. Weight loss
D. Acne

Explanation: **Explanation:** Combined Oral Contraceptive Pills (COCPs) contain both estrogen and progestogen. Their metabolic impact on the liver is a significant clinical consideration. **Why Liver Disorders is Correct:** The estrogen component (usually ethinylestradiol) in COCPs is metabolized in the liver. It can induce hepatic enzymes, alter bile composition, and decrease bile flow, leading to **cholestatic jaundice**. Long-term use is also strongly associated with **Hepatic Adenomas** (benign but vascular tumors). Therefore, COCPs are strictly contraindicated in patients with active liver disease, cirrhosis, or a history of cholestasis of pregnancy. **Analysis of Incorrect Options:** * **Pelvic Inflammatory Disease (PID):** COCPs actually **decrease** the risk of PID. The progestogen component thickens the cervical mucus, creating a physical barrier that prevents the upward migration of pathogens into the upper reproductive tract. * **Weight Loss:** Weight changes are a common concern, but COCPs are more frequently associated with minor **weight gain** due to fluid retention (estrogen) or increased appetite (progestogen), though large-scale studies show this effect is often negligible. * **Acne:** COCPs are a **treatment** for acne, not a cause. They increase Sex Hormone Binding Globulin (SHBG), which lowers free testosterone levels, thereby reducing sebum production. **High-Yield NEET-PG Pearls:** * **Cancer Risks:** COCPs **increase** the risk of Breast and Cervical cancer but are **protective** against Ovarian and Endometrial cancer (the "Rule of 2": 10 years of use reduces risk by 50% for 20 years). * **Cardiovascular:** The most serious acute side effect is **Venous Thromboembolism (VTE)** due to increased clotting factors (VII, X, and Fibrinogen). * **Absolute Contraindication:** Smokers >35 years of age (due to high risk of MI and stroke).

Question 160: The Yuzpe method is used for which of the following contraceptive techniques?

A. Sterilization using the 'No scalpel technique'
B. Emergency contraception with oral contraceptive pills (OCPs) (Correct Answer)
C. Emergency contraception with intrauterine devices (IUDs)
D. Evaluation of newer contraceptive methods

Explanation: **Explanation:** The **Yuzpe method** is a traditional regimen for **emergency contraception** that utilizes combined oral contraceptive pills (COCPs). It involves the administration of high doses of Ethinyl Estradiol (EE) and Levonorgestrel (LNG) in two divided doses. 1. **Why Option B is correct:** The standard Yuzpe regimen consists of **100 mcg of Ethinyl Estradiol + 0.5 mg of Levonorgestrel**, taken twice, exactly 12 hours apart. It must be initiated within **72 hours** of unprotected intercourse. It works primarily by inhibiting or delaying ovulation. 2. **Why other options are incorrect:** * **Option A:** "No scalpel technique" refers to a specific method of **Vasectomy** (male sterilization), not hormonal contraception. * **Option C:** Emergency contraception with IUDs (specifically the Copper-T 380A) is the most effective method of emergency contraception, but it is not referred to as the Yuzpe method. * **Option D:** The Yuzpe method is an established protocol (first described in 1974) and is not a framework for evaluating new drugs. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** While the Yuzpe method is historically significant, the current **drug of choice** for emergency contraception is **Levonorgestrel (1.5 mg single dose)** due to better efficacy and fewer side effects (nausea/vomiting). * **Time Frame:** Both Yuzpe and LNG methods are licensed for use up to 72 hours, though they may show some efficacy up to 120 hours. * **Side Effect Management:** Nausea is common with the Yuzpe method due to the high estrogen content; an antiemetic is often prescribed 30 minutes before the dose. * **Ulipristal Acetate:** A selective progesterone receptor modulator (30 mg) is another effective emergency contraceptive used up to 120 hours.

Practice by Chapter

Natural Family Planning Methods

Practice Questions

Barrier Methods

Practice Questions

Hormonal Contraceptives

Practice Questions

Intrauterine Devices

Practice Questions

Emergency Contraception

Practice Questions

Permanent Contraception Methods

Practice Questions

Contraception in Special Populations

Practice Questions

Contraceptive Counseling

Practice Questions

Side Effects and Complications of Contraceptives

Practice Questions

Future Contraceptive Technologies

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free